Acesso minimamente invasivo para troca da valva aórtica: resultados operatórios imediatos comparativos com a técnica tradicional

Abstract

Objective: Minimally invasive heart surgeries are approaches used to reduce trauma, to give better cosmetic results and to reduce hospital costs with the same safety as conventional surgery. This study was designed to compare the operative results from patients who underwent minimally invasive aortic valve replacement with those who were submitted to the standard procedure.Method: The operative and immediate postoperative results of 12 consecutive patients who received minimally invasive isolated aortic valve replacements from June 2002 to February 2003 were compared to 12 patients who underwent to traditional approach in the same institution. The minimally invasive access used was superior median hemisternotomy where cardiopulmonary bypass was established through ascending aorta and right atrium cannulation, similar to the traditional technique.Results: The demographics of the patients were similar in both groups. There were no significant differences between aortic clamping time, total bypass time and operating time. The skin incision length was statistically shorter in the minimally invasive group. In the postoperative course, the mechanical ventilation time and the total hospital stay were shorter, but not statistically significant, in the minimally invasive group. The morbidity was the same in two groups.Conclusions: This surgical approach provides adequate exposure of the cardiac structures necessary to perform a safe valve replacement. With the same instruments used in the traditional surgery we can offer the benefits of a less invasive access with the same efficiency as in the conventional approach without adding any risks to our patients. Descriptors

Minimally invasive aortic valve replacement: an alternative to the conventional technique

“…In this cases series, CPB was used in a conventional manner and was not vacuum-assisted since the cannulation was transthoracic occupying the same surgical field. This surgical option required larger chest incisions, reducing the aesthetic benefit and the expected reduction of postoperative discomfort [27][28][29].…”

Aortic Valve Replacement: Treatment by Sternotomy versus Minimally Invasive Approach

“…Four studies did not show significant differences for these parameters between MIS and sternotomy [ 4 , 9 , 10 , 20 ] . In accordance with the literature, in our study we also found a tendency for shorter time of stay in the ICU and hospital stay for the MIS approach, although not statistically significant, possibly due to the number of patients evaluated.…”

“…Among 14 studies comparing the length of stay in the ICU and length of hospital stay, 10 of them concluded that the MIS approach decreased the length of hospital stay [ 3 , 5 , 6 , 11 , 12 , 14 , 16 , 18 , 22 ] , and among these 7 studies also showed shorter length of stay in the ICU [ 10 , 14 , 16 - 18 , 23 , 24 ] . Four studies did not show significant differences for these parameters between MIS and sternotomy [ 4 , 9 , 10 , 20 ] . In accordance with the literature, in our study we also found a tendency for shorter time of stay in the ICU and hospital stay for the MIS approach, although not statistically significant, possibly due to the number of patients evaluated.…”

“…Hospital mortality was assessed in 12 studies, and in 10 of them there were no differences between the two approaches [ 9 , 10 , 12 , 18 , 20 , 21 23 , 25 , 26 ] . In two related studies, there was a reduction in mortality in the MIS approach [ 4 , 16 ] .…”